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What works in implementing patient decision aids in routine clinical settings? A rapid realist review and update from the International Patient Decision Aid Standards Collaboration

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Joseph-Williams, N, Abhyankar, P, Boland, L, Bravo, P, Brenner, AT, Brodney, S, Coulter, A, Giguere, A, Hoffman, A, Korner, M, Langford, A, Legare, F, Matlock, D, Moumjid, N, Munro, S, Steffensen, KD, Stirling, C ORCID: 0000-0003-2723-8302 and van der Weijden, T 2020 , 'What works in implementing patient decision aids in routine clinical settings? A rapid realist review and update from the International Patient Decision Aid Standards Collaboration' , Medical Decision Making , pp. 1-31 , doi: 10.1177/0272989X20978208.

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Abstract

Background: Decades of effectiveness research has established the benefits of using patient decision aids (PtDAs), yet broad clinical implementation has not yet occurred. Evidence to date is mainly derived from highly controlled settings; if clinicians and health care organizations are expected to embed PtDAs as a means to support person-centered care, we need to better understand what this might look like outside of a research setting.Aim: This review was conducted in response to the IPDAS Collaboration's evidence update process, which informs their published standards for PtDA quality and effectiveness. The aim was to develop context-specific program theories that explain why and how PtDAs are successfully implemented in routine healthcare settings.Methods: Rapid realist review methodology was used to identify articles that could contribute to theory development. We engaged key experts and stakeholders to identify key sources; this was supplemented by electronic database (Medline and CINAHL), gray literature, and forward/backward search strategies. Initial theories were refined to develop realist context-mechanism-outcome configurations, and these were mapped to the Consolidated Framework for Implementation Research.Results: We developed 8 refined theories, using data from 23 implementation studies (29 articles), to describe the mechanisms by which PtDAs become successfully implemented into routine clinical settings. Recommended implementation strategies derived from the program theory include 1) co-production of PtDA content and processes (or local adaptation), 2) training the entire team, 3) preparing and prompting patients to engage, 4) senior-level buy-in, and 5) measuring to improve.Conclusions: We recommend key strategies that organizations and individuals intending to embed PtDAs routinely can use as a practical guide. Further work is needed to understand the importance of context in the success of different implementation studies.

Item Type: Article
Authors/Creators:Joseph-Williams, N and Abhyankar, P and Boland, L and Bravo, P and Brenner, AT and Brodney, S and Coulter, A and Giguere, A and Hoffman, A and Korner, M and Langford, A and Legare, F and Matlock, D and Moumjid, N and Munro, S and Steffensen, KD and Stirling, C and van der Weijden, T
Keywords: implementation, patient decision aids, rapid realist review, realist methods, shared decision making
Journal or Publication Title: Medical Decision Making
Publisher: Sage Publications Inc
ISSN: 0272-989X
DOI / ID Number: 10.1177/0272989X20978208
Copyright Information:

Copyright 2020 the authors. Licensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/

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